Holding Calquence (acalabrutinib) for epidural injection.

[Bluesinthenight]

Recommendations seem to vary about the length of time to hold calquence for an epidural injection (L3-4 facet joint for my right sided sciatic pain) or other minor procedure. I know there is a bleeding risk even without procedures such as this one, but I do not wish to discontinue a highly effective therapy for long. I can accept holding for 3days before and 3days after, but wonder what others have heard or seen regarding recommendations for holding this drug. A definitive study is probably not easily done, and I suspect there is no set answer for this issue.

[CycleWonder]

I am on Pitrubrutinib, a noncovalent BTK inhibitor. I had a nerve block followed several weeks later by a nerve obliteration in my back. I did not stop my medication. At the time, my platelets were normal.

[Bluesinthenight in reply to CycleWonder]

Thank for sharing that, CycleWonder. I have had one prior epidural injection without holding my BTK inhibitor, and there were no problems (counts were lowish but OK)

[albie58]

What does your hematologist say?

[Bluesinthenight in reply to albie58]

He says hold for 5 days before and 5 days after. Ten days total off Calquence. I've discussed another recommendation by a hematologist specializing in CLL research and treatment to hold 3 days before and after. But reports of bleeding complications are lacking. I can't find anything other than concern for bleeding. Yet blood draws and vaccinations do not require holding the drug.

[Newdawn Administrator]

It’s a contentious one and your haematologist will probably have the casting vote. My haematologist took the view my Ibrutinib should not be temporarily ceased for more minor invasive procedures and said he couldn’t understand why it continued during a BMB and not other procedures.

Are your platelets sound?

Newdawn

[Bluesinthenight in reply to Newdawn]

I would expect a much higher risk of bleeding after a bone marrow bx than with a small needle epidural facet joint injection. I have bruised after BMB but nothing serious or painful. Serious bleeding must be rare.

My platelets are low normal and the provider doing the epidural injection requires plts of at least 80,000/mm. Some will accept 70,000/mm.

[skipro]

Not sure. My doc said I could continue on my Ven for an ESI but I held off on the injection because I had a blister that was not healing and was concerned about infection.

[Eucalyptus22]

As my bloods have been stable for 3.5 years I was able to come off Acalabrutinib for 3 weeks on 2 separate occasions without any detrimental effect. My consultant didn't have a problem and he actually asked me to pause my drug the first occasion so I might get a meaningful vaccine response ( which I did).

Kate

[Nucleusman]

3 days either side seems to be ok

[thompsonellen2]

I had a bone marrow biopsy and a lumbar puncture day over day and they didn't hold meds. I did bleed a little but it stopped quickly.

[sportage21]

I just had a basal cell carcinoma removed from my right cheek. When I asked the nurse at the dermatologists whether I should pause the acalabrutinib before the surgery, she replied that since my last lab tests were good, it wasn't necessary. I had the surgery done without complications.

[Cindi73]

I've been on Imbruvica since 2018. I was told for my epidural 3 days before n 3 days after. Hope you fine relief. Mine only lasted 6 weeks. Decided to try acupuncture. It's a miracle. I suffer a yr not being able to walk long. Acupuncture has helped me for many things. Wish you the best. Cindi p